Portal Hypertension (cont.)

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

Jerry R. Balentine, DO, FACEP

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

What are the symptoms of portal hypertension?

When blood cannot easily flow through the liver architecture (from portal
vein to sinusoids to hepatic vein to Vena cava), it tries to bypass the portal
system, using the systemic venous system to return to the heart. Symptoms of
portal hypertension are due to the complications of decreased blood flow through
the liver, and from increased pressure within the veins where blood is shunted.

Varices describe enlarged veins. Blood
meant for the portal system, is diverted to and gathers other veins as it makes
its way to the heart. These varices can occur in the esophagus, stomach, around
the umbilicus and in the anus and rectum.

Esophageal and gastric varices are at
risk for life threatening bleeding and can have signs and symptoms with
vomiting blood and
blood
in the stool. Melena describes black,
tarry stool that is the result of upper
gastrointestinal bleeding.

Ascites describes abnormal fluid
collection within the peritoneum (the sac that contains the intestines within
the abdominal cavity) and is due to decrease protein in the body. The liver
produces the body's protein and portal hypertension and the underlying liver
disease decreases its ability to function.

Hepatic encephalopathy is another
complication of liver disease, causing confusion and lethargy
due to the
buildup of waste products and the inability of the liver to adequately filter
them.

Splenomegaly or enlargement of the
spleen. Because of portal hypertension, blood backs up, and this also can trap the
components of blood (red blood cells, white blood cells and platelets) within
the spleen causing anemia and thrombocytopenia (low platelet count in the
bloodstream).

Decreased white blood cell counts
increase the risk of general infection. Spontaneous bacterial peritonitis
is an infection within the peritoneal sac within the abdomen, and is seen as
a consequence of long standing portal hypertension.